Reiteration

It is important to see Schairerand Schöniger's paper againsta backdrop of the history of tobacco, the history of cancer,andthe history of how a causal link between the two came tobe recognized. Schairerand Schöniger's paper also hasto be seen, though, as a political document, a product of theNazi ideological focus on tobacco as a corrupting force whoseelimination would serve the cause of ‘racial hygiene’.Nazi Germany was governed by a health-conscious political elitebent on European conquestand genocidal extermination, andtobaccoat this time was viewed as one among many ‘threats’to the health of the chosen Volk.

Exploring this larger political context in this sense tellsus something interesting about the nature of theNazi regime.Nazism was a movement of muscular, health-conscious young menworried about things like the influence of Jews in German cultureandthe evils of communism, but also about the injurious effectsof white bread, asbestos and artificial food dyes. Hitler himselfwas a vegetarian and did not smoke or drink; Nazi anti-tobaccoactivists often pointed out that while the three leading fascistleaders of Europe all abstained from tobacco (Mussolini, Franco,and Hitler), the three leading Allied leaders (Churchill, Rooseveltand Stalin) were all heavy users.1

Cancer rates on the rise

Tobacco use skyrocketed at the end of the nineteenth century,following the invention of safety matches (in 1852), the riseof mass consumer marketing, andthe invention of the Bonsackcigarette rolling machine (in 1884), which allowed industrial-scaleproduction. Cigarettes were given to soldiers in the First WorldWar, creating an entirely new generation of addicts; nationalgovernments also found in tobacco a marvellous source of income,since sales were easily regulated and effectively taxed. Cigarettesbecame the preferred mode of smoking toward the end of the century,following the development of ‘flue-curing,’ a fermentationprocess that allowed tobacco smoke to be inhaled without coughing.Cigarettes were also more easily packaged and carried than otherkinds of tobacco—the prepackaged white casings being interestinglysimilar in this regard to the prepackaged ammunition cartridgesinvented about this time, with comparable deadly effects.

As a result of the rapid growth of cigarette consumption, cancerrates rose explosively in the first decades of the twentiethcentury. Lung cancer had been an extremely rare disease priorto 1900—with only 140 documented cases worldwide2—thoughby the 1930s the disease was the number two cause of cancerdeath among males in Germany, second only to stomach malignancies.3A 1944 study would show that lung cancer had actually surpassedstomach tumours to become the leading cause of cancer deathamong soldiers in the German army, a result not inconsistent,in this military man's view, with a tobacco aetiology.4

Though German pathologists in the 1920s were among the firstto recognize the reality of a lung cancer epidemic,5 cigaretteswere not widely blamed until the 1930s. Cigarettes had occasionallycome under suspicion (not before 1900, interestingly), but themore common view held that road tar or car exhaust or the fluepidemic of 1919 or even racial mixing or the chemical warfareagents used in World War I were the primary culprits. Therewere some stragglers who thought that the entire phenomenonmight be a statistical artefact of either better diagnosis (notablyby X-rays, but also improved bronchoscopy) or more extensivehospitalization, but by the late 1920s pathology institutesin the German-speaking world had mortality statistics reliableenough to show that theLungenkrebs epidemic was real, and accelerating.

Fritz Lickint of Dresden published the first good statisticalevidence of a lung cancer tobacco link in 1929, based on a caseseries showing that lung cancer sufferers were likely to besmokers. Lickint also argued that tobacco use was the best wayto explain the fact that lung cancer struck men four or fivetimes more often than women (since women smoked much less) andthat in countries where women also smoked, the sex differencewas much smaller.6

Adam Syrek in 1932 at the University of Cracau argued similarlythat it was hard to reconcile a non-tobacco aetiology with themortality patterns he was finding in rural Poland. Syrek showedthat many of the lung cancer deaths recorded at his institutewere from rural areas, where cigarette smoking had become popularand polluting industries were virtually non-existent. Syrekalso showed that the epidemic had struck Cracau itself, wherethere were still very few cars and little industry to speakof. The flu epidemic was also an unlikely cause, in his view,since both sexes were equally afflicted by flu. By a processof elimination, Syrek came to the conclusion that tobacco wasthe most likely cause of the epidemic.7

TheNazi impulse

The rise of theNazi regime to power in January 1933 producedseveral major transformations in German science. Many areasof science with strong Jewish representation—psychoanalysisand certain areas of theoretical physics, for example—lostmany of their leading lights, though other fields, with relativelyfew Jews, fared better. Sciences that could be regarded as freeof Jewish influence, or as useful to the military or racialgoals of the regime, were often encouraged.

Prevention-oriented cancer research was one such area. Partof this had to do with the ‘homeopathic paranoia’of the regime (my term)—the fear that small but powerfulagents were undermining the German Volkskörper. The carcinogeniceffects of food dyes became a focus of considerable interest,as did the radiogenic lung carcinomas of uranium miners (theso-called ‘Schneeberger’ or ‘JoachimstalerKrankheit,’ caused by exposure to radon gas in theErzgebirgeof southeast Germany andthe German-Czech border), the perilsof mercury dental fillings, andthe carcinogenic impact of asbestos.By 1939, for example, occupational authorities were routinelylisting lung cancer as one of the occupational hazards of exposureto asbestos dust.8There was a great deal of worry about howto maintain the ‘purity’ of Germany’s food,air and water, a concern linked ideologically to the more notorious(and eventually criminal) efforts to eliminate ‘foreignracial elements’ from the German population.

This questfor bodily purity was not unique to Nazi Germany,of course—think of the eugenic fervour of some of America'searly natural food advocates or even the post-World War II fearof fluoridation, captured dramatically in a remarkable sequencein Stanley Kubrick's film, Dr Strangelove, which has a ColdWar-era general obsessing over threats to his ‘preciousbodily fluids’. TheNazis carried this quest further thanother contemporary nations, prompting them to engage in certainareas of cancer research that from today's vantage point looksurprisingly progressive. This becomes particularly clear ifyou look at the source of support forSchairerand Schöniger'sresearch.

Astel's institute

Schairerand Schöniger's case-control epidemiological studywas financed by Karl Astel's Institute forTobacco Hazards Research(or ‘Institute forthe Struggle Against Tobacco Hazards’,as it was also known), established in 1941 at Jena Universityby a 100 000 Reichsmarks grant from Hitler's Reich Chancellery.We do not know who first suggested the study, though it couldwell have been Prof. Dr. med. Astel himself, who ruled overmuch of this intellectual territory with the iron hand expectedfrom a NaziFührer. Astel was a high-ranking SS officerand from 1939 president of the University of Jena; he was alsoan ardent anti-Semite and euthanasia advocate who served ashead of Thüringia's Office of Racial Affairs, an importantinstrument in the propagation of Nazi political ideals.

Astel was an early devotee of Hitler, having already marchedalongside his beloved Führer in September 1923 at a Nurembergrally, earning him the coveted Nazi ‘Golden Badge of Honor,’awarded to the first 100 000 people to join the NationalsozialistischeDeutsche Arbeiterpartei (NSDAP) (more than ten million peopleeventually joined the Party). Astel was also a rabid anti-tobaccoactivist, who quickly made a name for himself on the Jena campusby snatching cigarettes from the mouths of smoking students.His institute therefore, not surprisingly, sought to combineboth scientific and propagandist work. The institute purchasedand distributed 2000 copies of Hans FK Günther's 8-pageTrinken, Rauchen, Gattenwahl (Drinking, Smoking, and SpousalChoice) along with 15 copies of Lickint's Tabak und Organismus(at 50 RM each), hundreds of reprints from Reine Luft (PureAir), the most important anti-tobacco journal of the era, and3000 copies of Emil Skramlik's compilation of Goethe's viewson tobacco. Skramlik also received at least 15 000 RM to producean anti-tobacco film (Genussmittel Tabak)—and though muchof it was apparently finished by 1944, the film itself has sincedisappeared. Skramlik went on to become president of the Universityof Jena after the war, succeeding Astel, who shot himself inthe University Medical Clinic in April of 1945, after apparentlydestroying all his files.

Schairerand Schöniger's paper was largely based on Schöniger'smedical dissertation, submitted in 1944. Schöniger's, though,was only one of several dissertations produced at Astel's institute.Gabriele Schulze and Käte Dischner in their jointly writtenDie Zigarettenraucherin (‘The Female Cigarette Smoker’,Jena, 1942), for example, interviewed 165 women as part of astudy of the physical and psychological effects of nicotinewithdrawal. Most of the women studied were incarcerated at prisonsin Weimar, Gera or Kleinmuesdorf near Leipzig, where smokingwas forbidden; the dissertation records the women's cries forcigarettes, and attempts to classify female smokers by menstrualpatterns, ‘constitutional type’ (asthenic, pyknic,leptosome, etc.), and criminal behaviour. The authors claimedthat smoking made one vulnerable to tuberculosis and calledfor a total smoking ban for women, consistent with theNazislogan ‘Die deutsche Frau raucht nicht!’ (The Germanwoman does not smoke!).

Racial hygienists distinguished ‘positive’, ‘negative’and ‘preventive’ racial hygiene, encompassing: (1)encouragement of breeding among the ‘fit’ (e.g.by marital loans and prizes for large families); (2) limitationof breeding among the ‘unfit’ (especially by sterilization);and (3) prevention of exposure to genotoxic hazards. For Astel,preventive racial hygiene translated into a research effortto determine whether nicotine was a mutagen, in accordance withhis view that ‘We cannot change our genes, but at leastwe can safeguard them from future damage.’9

Astel therefore funded inquiries into whether nicotine or otherconstituents of tobacco smoke could be considered mutagens.Theracialtheorist Günther Just of Würzburg's RassenbiologischesInstitut was appointed a ‘Mitarbeiter’ at thetobaccoinstitute in March of 1943, and over the next 2 years received6000 RM to explore the genetic and hormonal damage caused bynicotine. The pharmacologist Gustav Kuschinsky of Prague receiveda total of 17 444 RM that same year from Astel's institute,to conduct a series of rat experiments to prove (with Karl Thumsof Prague) that smoking caused heritable genetic damage. Kuschinskywas still doing work on this project (without success) as lateas September 1944; he also worked forthe Reemtsma tobacco companyafter the war, doing similar work.

TheNazi government enacted numerous legal sanctions limitingtobacco use. Tobacco was banned in theatres and cinemas, andon buses and in many public buildings. Astel implemented thenation's first (modern) university tobacco ban, and smokingwas barred in post offices, military hospitals, and all Naziparty offices. Rationing was implemented at the outbreak ofthe campaign against Poland, making it hard even for Astel'sinstitute to obtain tobaccofor research purposes. In 1942,for example, Astel had to ask his anti-tobacco comrade, ReichHealth Führer Leonardo Conti, for help in obtaining adequatesupplies.

One reason tobacco was in short supply was that tobacco wasused to finance the war. In September 1942 a war tax nearlydoubled the price of cigarettes, which when coupled with agriculturalshortages andthe impoverishment late in the war caused a drasticdrop in the number of cigarettes smoked in Germany. Per capitacigarette consumption fell by half from 1940 to 1950, whereasin the US, per capita consumption doubled over the same period.

Hitler in 1942 said that he regretted having given his soldierstobacco at the start of the war. And though the decision wasclearly a pragmatic one, the power of tobacco manufacturersat this time should not be underestimated. The industry hadstrong friends in the ministries of economics and finance, bothof which were clearly afraid of interrupting the steady flowof cash from tobacco taxes, which in 1941 accounted for onetwelfth(!) of all revenues flowing into the national treasury.Anti-tobacco activists often lamented the financial clout ofthe industry, as we can see from the following passage in aletter of 21 April 1941, from Fritz Lickint to Astel, celebratingthe founding of the anti-tobacco institute:

Finally it will be possible to establish a true bulwark againstefforts by the heretofore omnipotent ‘tobacco interests’to monopolize tobacco research. Finally it will be possibleto counter the impression, created by the industry's researchinstitutes in Vienna andForchheim, that they alone have theright to speak the truth about tobacco, and to shape or evendominate public opinion concerning matters of tobacco.

The industry's voice was not so easily countered, however. Shortlyafter the founding of Astel's institute, the industry establishedits own information organ, the ‘Tabacologia medicinalis,’in a clear attempt to win thetobacco-health propaganda war.Leonardo Conti ordered the closing of the organization shortlythereafter, but it is possible to see this as the beginningof a new kind of clash that would re-emerge in America in themid-1950s, with theformation of theTobacco Institute andtheCouncil forTobacco Research, bodies skilfully designed to counterthe evidence of a global tobacco health catastrophe.

It was not the power of thetobacco industry that crushed Astel'sinstitute, but rather the defeat of Germany's armies. The institutecame to an end in the spring of 1945, when Astel committed suicide,recognizing his future in a post-Nazi world would not be a pleasantone. Astel had helped to organize the euthanasia operation thatmurdered some 200 000 mentally and physically disabled; he hadalso assisted in the ‘Final Solution of the Jewish Question’as head of the Thüringia's Office of Racial Affairs. Hadhe managed to survive the war, he most likely would have beentried as a war criminal. Astel had also made the Jena medicalfaculty a hotbed of Nazi activism—some instances of whichcan be seen in the highly questionable research promulgatedunder his reign.

The Waffen-SS physician Erich Wagner, for example, had donehis notorious dissertation on classifying tattoos among theconcentration camp inmates of Buchenwald under Astel's tutelage;Wagner committed suicide in 1959, when a court in Offenburgbegan legal proceedings against him for murder.10 Members ofthe Jena medical faculty had done other work at Buchenwald,some of which utilized their tobacco expertise. Friedrich Timmof Jena's Institute forForensic Medicine, for example, autopsiedthe body of an SS Hauptscharführer by the name of RudolfKöhler, who had died while interned in the camp on suspicionof corruption; Timm concluded that the man had committed suicideby ingesting a ‘large quantity of cigarette butts’.Astel's institute also entertained proposals to study how racialmixing, tobacco use, and ‘exploitation by Jewish capitalinterests’ affected the health of people living in tobacco-growingregions. Tobacco in the words of the author of this proposalwas to be classified not as a Lebensmittel (food) but ratheras a Sterbemittel (death agent).

Some of the institute's work involved human experiments. Theradiologist Wolf Dietrich von Keiser on 6 November 1941, forexample, wrote to Astel, asking for his assistance in procuring400 stormtroopers for a series of experiments to determine theeffects of nicotine on gastric function. The subjects were requiredto appear for 2 days in Keiser's surgical clinic at the Universityof Jena; one day they were fed nicotine, the other they werenot. The men were then X-rayed to determine effects on the stomach.Human experiments were also carried out on prisoners, andtherewas a fair amount of animal experimentation.

Normal science?

Schairerand Schöniger's work on tobaccoand lung canceris of interest, among other things, for what it tells us aboutthe fate of science in a totalitarian dictatorship. For onething, it shows that certain kinds of science can actually flourish,if they are not seen as contrary to the ideological goals ofsuch a state. Had Germany won the war, one can imagine thatAstel's institute would have continued producing sophisticatedscience; as it was the institute was formally dissolved in November1945, when Russian military authorities confiscated the fundsof Jena's Thüringische Staatsbank.

However, there is another interesting element to this story,which is that the paper translated here was by and large ignoredby post-war scientists. TheScience Citation Index reveals thatthe paper was cited three or four times in the 1960s, only oncein the 1970s, andthen not again until 1988, when Ernst Wyndercited it in an article in Public Health Reports. The paper wasunknown even in Germany, where one might have expected moresympathetic treatment. A 1953 German-language bibliography devotedexclusively to the topic of ‘Tobaccoand Cancer’does not include Schairerand Schöniger's article.11 Eventoday, Germans tend to present the history of tobacco/cancerresearch as if it were entirely an Anglo-American affair, ignoringlocal contributions. The fear may be that by acknowledging sucha work, one might somehow give credence to Nazis ideals or policy.The conventional view seems to be that Nazism gave birth onlyto monsters, and that anything with roots in this era must betainted.

There are other areas of biomedical science where similar viewsheld sway. James Watson in his book, The Double Helix, tellsthe story of how Gerhard Schramm's subtle studies on viral biochemistrywere ignored or dismissed by post-war scientists, thinking thatgood work simply could not have been done by Nazi scientists12(Schramm was a member of the SS and a key figure in Adolf Butenandt'sKaiser Wilhelm Institute for Biochemistry). Similar prejudicesmay have been at play with regard to German tobacco work—thoughlanguage barriers may also have played a role. Many wartime-eraGerman journals were never shipped abroad, a casualty of thedisintegration of international co-operation, but also a resultof subscription cutbacks, communications breakdowns, andtheboycott of German journals by several professional groups inAllied nations.

Tobaccoepidemiology was also not the kind of thing Allied militaryauthorities were interested in, when they began to comb throughGerman science and engineering in search of exploitable findings.No effort was made to exploit Germany's pioneering tobacco work,e.g. in theFIAT reviews of German science, a veritable EncyclopediaNaziana published shortly after the war by US and British militaryauthorities. The focus was rather on sciences that might proveof ‘strategic’ interest—defined in militaryterms. There is an interesting irony here, insofar as rocketbombs and aerotechnical engineering skills were exploited—oftento the point of kidnapping and transferring the scientists themselvesabroad—when sciences that could have clearly helped savelives were ignored. US priorities in this area became clearwhen an effort was launched to resupply Germany with tobacco.In 1948 and 1949, the US shipped 93 000 tons of blond Virginia-blendtobacco free of charge to the defeated nation as part of theMarshall Plan.13

Perhaps I may end with a speculation, that the net effect oftheNazi war on tobacco—and I am talking only about Germanyhere—was actually to forestall the development of effectiveanti-tobacco measures by several decades. Nazi ideals seem tohave helped foster some world-class tobacco science (think alsoof Franz Müller's paper, which actually came to strongerconclusions than Schairerand Schöniger's),14 but theyultimately dragged it down, both by destroying the German economyand by tainting Nazi-era research with some of history's mostinhumane policies. In the post-war era, memories of Nazi-endorsedasceticism were not exactly pleasant ones. Nor did tobacco controlfit very well with the consumerist urges of the 1950s or themore carefree bacchanalian ethics of the late 1960s and 1970s.Germany today has one of Europe's worst records in the areaof tobacco control, despite being home to some of the world'sfirst tobaccoepidemiology. European and American tobacco companieshave both tried to play theNazi card, associating smoking restrictionswith Nazi-like policings.15

One of the jobs of the science historian, however, is to explorehow strange and unexpected historical forces can influence theflourishing (or stifling) of science. The resurrection of thispioneering paper will hopefully throw new light on a largelyforgotten chapter of tobacco science, andthe curious politicalcircumstances in which it arose.